Chronic inflammatory demyelinating polyneuropathy
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Chronic Inflammatory Demyelinating Polyneuropathy. By : Kyle Leato, SPTA. OBJECTIVES. Provide background information Clinical Presentation Cause Treatment Importance to Physical Therapy Conclusion. Background Information. What is CIDP?

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Chronic Inflammatory Demyelinating Polyneuropathy

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Chronic inflammatory demyelinating polyneuropathy

Chronic Inflammatory Demyelinating Polyneuropathy

By: Kyle Leato, SPTA


Objectives

OBJECTIVES

  • Provide background information

  • Clinical Presentation

  • Cause

  • Treatment

  • Importance to Physical Therapy

  • Conclusion


Background information

Background Information

  • What is CIDP?

    • It is a common, under diagnosed immune-mediated inflammatory disorder of the peripheral nervous system. (Hartung, et al., 2005)

  • Commonly referred to as:

    • chronic relapsing polyneuropathy

  • Closely related to:

    • Guillain-Barré syndrome.

  • Prevalence:

    • 0.5 out of 100,000 children

    • 1-2 per 100,000 adults


Cidp vs guillain barr

CIDP vs. Guillain-Barré


Cause

Cause

  • The body’s immune system attacks the nerves in the periphery, affecting the limbs and organs of the body

(Forsberg, Press & Westblad, 2009)


Symptoms

Symptoms

  • Occurrence of symmetrical weakness in both proximal and distal muscles that progressively increases for more than 2 months.

  • Impaired sensation, burning and weakness ( generally occurring in the feet first and they gradually ascend to involve other parts of the body). 

  • Absent or diminished tendon reflexes.

  • Elevated CSF protein level.

  • Signs of demyelination (in nerve biopsy specimens).

  • Foot drop.

  • When organs become involved: inability to adequately empty the bladder, nausea, vomiting, abdominal fullness or bloating, diarrhea, or constipation, low blood with dizziness, or trouble maintaining an erection. 

    ****The severity and the combination of symptoms vary for each patient.


Treatment

Treatment

  • Early Stages:

    • Typically PROM and positioning is used.

    • Family Education

  • Middle Stages:

    • Tactile re-training (brushing, vibration and tapping)

    • Light resistive exercises

    • PNF if the patient is capable

  • Late Stages:

    • Transfer Training

    • Gait Training with the use of an AD

    • Progressive Resistive Exercises


Other treatment ideas

Other Treatment Ideas

  • Land Based Exercising:

    • Alter G Treadmill for reduced body weight walking. Increased weight bearing over a period of time is shown to increase strength and the ability to ambulate independently. (Greenwood & Tuckey, 2004)

  • Water Based Exercise:

    • Hydro Physio Underwater Treadmill can be altered by increasing or decreasing the amount of water in the tank.

    • Aquatic therapy has shown to be very beneficial to one of our own patients.


Youtube video

Youtube Video

https://www.youtube.com/watch?v=6Y1glEYQAJs


Importance in relation to physical therapy

Importance in Relation to Physical Therapy

  • What can we as a physical therapy team do?

    • Be prepared to treat the patient on a day-to-day basis because every day can be a day of progression and/or setbacks. Be ready for anything.

    • Interdisciplinary communication between medical team, occupational therapy and speech therapy.

    • We can provide education for the patients and their support systems.

    • Maintain a positive attitude and optimistic outlook.

    • MOVEMENT IS THE BEST MEDICINE!


Conclusion

Conclusion

  • It’s important to know that CIDP is a unique diagnosis to each and every patient. (Barohn, et al., 2010)

  • No treatment will be the same, therefore it is important to be aware of their past history, their past and current symptoms, as well as their current lifestyle.

  • There is no specific “cure” that physical therapy can provide, so we make it a goal to use the techniques, exercises and knowledge that we have in order to best improve the quality of the life of the patient.


References

References

  • Barohn, et al. Chronic Inflammatory Demylinating Polyneuropathy Disease Activity Status: Recommendations for Clinical Research Standards and Use In Clinical Practice. Journal of the Peripheral Nervous System. 2010; 15(4): 326-333.

  • Forsberg A, Press R, Westblad ME. Disability and health status in patients with chronic infammatory demyelinating polyneuropathy. Disability & Rehabilitation. 2009; 31(9): 720-725.

  • Greenwood R , Tuckey J. Rehabilitation after severe Guillain-Barré syndrome: the use of partial body weight support. Physiotherapy Research International. 2004; 9(2): 96-103.

  • HartungH, JanderS, Kieseier BC, Köller H. Chronic inflammatory demyelinating polyneuropathy. N Engl J Med. 2005; 352: 1343-1356.


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